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Kaiser nixes acute mental illness beds

Officials change focus of Sunnyside center; experts point to the high cost of care

The Portland-area shortage of inpatient beds for people suffering acute mental illness is not going to get the relief many anticipated.
Kaiser Permanente officials have decided not to open 40 new acute psychiatric beds in their new facility near Clackamas Town Center, as was planned.
During the past 10 years, the number of hospital beds available to psychiatric patients in Portland and Salem-area hospitals has steadily dropped, from more than 500 to about 150 today.
As a result, people suffering mental illness — many of them brought to hospitals by ambulance or police while in the midst of a psychotic episode — who needed one of those beds have had to wait.
Some wait in hospital emergency departments, sometimes for days. Others are sent to other hospitals, often out of town, in a desperate search for a bed in a hospital psychiatric unit.
Mental health advocates were heartened by Kaiser’s announcement, a little more than a year ago, that the health maintenance organization was going to build a separate psychiatric wing at its expanded Sunnyside Medical Center.
The wing would hold 40 new psychiatric beds, Kaiser officials said then, and the beds not used by Kaiser patients would be available to help ease the communitywide shortage.
But Kaiser officials said this week that they’ve changed their minds. While Kaiser’s new wing, called Brookside Center, has been completed and is set to begin operating in June, it won’t be open to people suffering acute mental illness.
Instead, according to Kaiser officials, the facility will be a residential center for Kaiser patients receiving treatment for substance abuse and nonacute mental illness.
Patients sent elsewhere
Kaiser patients who need acute inpatient psychiatric beds will continue to be sent to Providence St. Vincent Medical Center in Southwest Portland and Providence Portland Medical Center in Northeast Portland under terms of a contract between Kaiser and the Providence hospitals, according to Kaiser officials.
Mental health advocates said the change in policy represented a significant loss.
“It would have been a big gain to get them,” said Jason Renaud, a board member of the Mental Health Association of Portland. “It would have relieved a great burden from emergency rooms.”
Melinda Howard, interim administrator for Brookside Center, said a second look at Kaiser’s psychiatric patients led to the change in policy. According to Howard, the majority of Kaiser patients who have received treatment in Portland-area hospital psychiatric units didn’t need acute inpatient care. They just had no other place to go, Howard said.
Howard said that by opening the Brookside Center to treat those who are not suffering acute mental illness Kaiser still would help alleviate the pressure for acute psychiatric beds.
“By not sending our members to that acute level of care and taking care of them ourselves, we’re freeing up those beds that are desperately needed for people in the community who do need that level of care,” Howard said. “So we are improving the situation in the community.”
Howard said the expense of operating acute psychiatric beds was not the reason for the change. But some in the mental health community say they have doubts.
Costs can be high
Psychiatric rooms typically cost more to maintain than regular hospital rooms. Because they often accommodate suicidal patients, they require special designs, from shower heads to doorknobs, to ensure patient safety.
In addition, staffing costs are higher because patients suffering acute psychiatric symptoms need frequent supervision and visual checks. And liability costs for treating the acutely mentally ill are high.
“Liability is a tremendous disincentive on (hospitals) to do acute care,” Renaud said.
“I don’t know the financial numbers, but my assumption is that what Kaiser does is all financially motivated,” Renaud said. “They’re a business, and I expect them to follow a business model.”
“It all goes back to the ‘Jerry Maguire’ movie. Show me the money,” said Portland resident Angela Kimball, director of state policy for the National Alliance on Mental Illness. “These are not profit centers, and increasingly hospitals are finding it difficult to justify keeping those units open.”
Kimball said she regularly hears of Portland psychiatric patients being taken to other cities because there are no local beds available for them. The loss of 40 more beds, she said, would only make a bad situation worse, especially for those suffering mental illness who do not have insurance coverage.
“Basically what I see happening is you force everybody into the criminal justice system or into homelessness,” she said.
The Kaiser decision is bad news from the police point of view, according to Sgt. Brian Schmautz, spokesman for the Portland Police Bureau. Schmautz said the lack of beds for police to take the mentally ill is “a devastating problem for us.”
Many of the mentally ill picked up by police are indigent, Schmautz said.
“These people involved with mental health need a place to go to get help,” Schmautz said. “Sometimes there just aren’t beds, or they get to these places where there is a bed and somebody bumps them out a day later. What ultimately occurs is they end up being arrested for crimes and jailed, which is not the best place for a person with mental illness.”
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